External validation of three lymph node ratio-based nomograms predicting survival using an international cohort of patients with resected pancreatic head ductal adenocarcinoma

European Journal of Surgical Oncology, vol. 48, pp. 2002–2007

Abstract

INTRODUCTION: Lymph node ratio (LNR) is an important prognostic factor of survival in patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to validate three LNR-based nomograms using an international cohort. MATERIALS AND METHODS: Consecutive PDAC patients who underwent upfront pancreatoduodenectomy from six centers (Europe/USA) were collected (2000-2017). Patients with metastases, R2 resection, missing LNR data, and who died within 90 postoperative days were excluded. The updated Amsterdam nomogram, the nomogram by Pu et al., and the nomogram by Li et al. were selected. For the validation, calibration, discrimination capacity, and clinical utility were assessed. RESULTS: After exclusion of 176 patients, 1'113 patients were included. Median overall survival (OS) of the cohort was 23 months (95% CI: 21-25). For the three nomograms, Kaplan-Meier curves showed significant OS diminution with increasing scores (p < 0.01). All nomograms showed good calibration (non-significant Hosmer-Lemeshow tests). For the Amsterdam nomogram, area under the ROC curve (AUROC) for 3-year OS was 0.64 and 0.67 for 5-year OS. Sensitivity and specificity for 3-year OS prediction were 65% and 59%. Regarding the nomogram by Pu et al., AUROC for 3- and 5-year OS were 0.66 and 0.70. Sensitivity and specificity for 3-year OS prediction were 68% and 53%. For the Li nomogram, AUROC for 3- and 5-year OS were 0.67 and 0.71, while sensitivity and specificity for 3-year OS prediction were 63% and 60%. CONCLUSION: The three nomograms were validated using an international cohort. Those nomograms can be used in clinical practice to evaluate survival after pancreatoduodenectomy for PDAC.

Authors 14

1. Michael H. Schneider

   Centre Hospitalier Universitaire Vaudois

   Affiliation as printed

   Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

2. Ismaïl Labgaa

   Centre Hospitalier Universitaire Vaudois

   Affiliation as printed

   Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

3. Dionisios V. Vrochides

   Carolinas Medical Center

   Affiliation as printed

   Division of Hepatobiliary and Pancreatic Surgery, Carolinas Medical Center, Charlotte, USA

4. Alessandro Zerbi

   Humanitas University

   Affiliation as printed

   Humanitas Clinical and Research Center - IRCCS, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Milan, Italy

   Department of Biomedical Sciences, Humanitas University, Milan, Italy

   Humanitas Clinical and Research Center - IRCCS, Milan, Italy

5. Gennaro Nappo
   Affiliation as printed

   Humanitas Clinical and Research Center - IRCCS, Milan, Italy

6. Julie Périnel

   Centre Hospitalier Universitaire Vaudois · Hôpital Orthopédique de la Suisse Romande · Hôpital Edouard Herriot

   Affiliation as printed

   Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland; Department of Digestive Surgery, Edouard Herriot Hospital, Lyon, France

   Department of Digestive Surgery, Edouard Herriot Hospital, Lyon, France

   Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

7. Mustapha Adham

   Hôpital Edouard Herriot

   Affiliation as printed

   Department of Digestive Surgery, Edouard Herriot Hospital, Lyon, France

8. Stijn van Roessel

   Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam

   Affiliation as printed

   Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands

9. Marc G. Besselink

   Amsterdam University Medical Centers · Cancer Center Amsterdam · University of Amsterdam

   Affiliation as printed

   Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands

10. J. Sven D. Mieog Aachen Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands

11. Jesse V. Groen Aachen Department of Surgery, Leiden University Medical Center

    Leiden University Medical Center

    Affiliation as printed

    Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands

12. Nicolas Demartines corresponding

    Centre Hospitalier Universitaire Vaudois

    Affiliation as printed

    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland. Electronic address: demartines@chuv.ch

    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

13. Markus Schäfer

    Centre Hospitalier Universitaire Vaudois

    Affiliation as printed

    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

14. Gaëtan‐Romain Joliat

    University of Bern · Centre Hospitalier Universitaire Vaudois · Hôpital Orthopédique de la Suisse Romande

    Affiliation as printed

    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland; Graduate School for Health Sciences, University of Bern, Switzerland

    Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

    Graduate School for Health Sciences, University of Bern, Switzerland